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Utilization Review Assistant Jobs (NOW HIRING)

Orison

RN - Utilization Review

Elmhurst, NY · On-site

... clinical review is required. * Assist with authorization requests, denials, appeals, and ... Non-acute utilization review. Skills: RN,REGISTERED NURSE

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Clinical Medical Assistant Certification (CMAC) preferred. * Certified Revenue Cycle Representative ...

Orison

RN - Utilization Review

Elmhurst, NY · On-site

... clinical review is required. * Assist with authorization requests, denials, appeals, and ... Non-acute utilization review. Skills: RN,REGISTERED NURSE

UF Health

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Clinical Medical Assistant Certification (CMAC) preferred. * Certified Revenue Cycle Representative ...

Socket.dev

Manager, Utilization Review

Gainesville, FL · On-site

Overview The Manager of Utilization Review provides operational leadership and oversight for ... Clinical Medical Assistant Certification (CMAC) preferred. * Certified Revenue Cycle Representative ...

Hired by Matrix

RN Utilization Review

Portales, NM · On-site

Job Title: RN Utilization Review City: Portales State: NM Job Type: Travel Discipline: RN ... necessary. * assist with obtaining referrals, prior authorization for Home Health Care, CME, SNF ...

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Utilization Review Assistant information

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How much do utilization review assistant jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for utilization review assistant in the United States is $30.95, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $37.98 per hour, depending on experience, location, and employer.

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

How do I get into a utilization review assistant?

To become a utilization review assistant, candidates typically need a high school diploma or equivalent, with some roles preferring healthcare-related certifications or experience. Strong organizational skills, attention to detail, and familiarity with medical records and insurance processes are important; some positions may require knowledge of healthcare management software. Gaining relevant experience or certifications can improve job prospects in this field.
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Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 1% Temporary, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $64,366 per year, or $30.9 per hour.

RN - Utilization Review

New York, NY

Orison Solutions
See more jobs at Orison Solutionsexternal

$65 - $70/hr

Contractor

Posted 10 days ago

Job description

Job Summary


We are seeking an experienced Registered Nurse (RN) - Utilization Review to evaluate the medical necessity, appropriateness, and level of care for patients. The RN will review clinical documentation, apply established medical guidelines, and collaborate with physicians, case managers, health plans, and other healthcare professionals to ensure appropriate utilization of healthcare services.

Key Responsibilities

  • Conduct prospective, concurrent, and retrospective utilization reviews of patient records.
  • Evaluate medical necessity and appropriateness of admissions, continued stays, procedures, and levels of care.
  • Review clinical documentation and medical records to determine whether services meet established criteria.
  • Apply evidence-based guidelines such as InterQual, MCG, CMS, and payer-specific criteria, as applicable.
  • Communicate with physicians and other healthcare providers regarding clinical information and utilization decisions.
  • Identify opportunities for appropriate resource utilization and cost-effective care.
  • Collaborate with Case Management, Quality Management, Medical Directors, and insurance companies.
  • Prepare and maintain accurate documentation of utilization review activities.
  • Escalate cases to the appropriate physician advisor or Medical Director when criteria are not met or additional clinical review is required.
  • Assist with authorization requests, denials, appeals, and reconsiderations when applicable.
  • Ensure compliance with applicable healthcare regulations, organizational policies, and payer requirements.
  • Maintain confidentiality of patient information in accordance with HIPAA regulations.
Required Certifications & Licensure
  • New York State RN License.
  • Primary Source Verification.
  • AHA BLS.
Required Skills & Experience
  • One (1) year of non-acute utilization review experience.
Preferred Skills & Experience
  • RN experience.
Skills
  • Non-acute utilization review.